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NPI Code Detail

MEDICARE: JONNIEANN SOPER

MEDICARE: JONNIEANN SOPER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106E00000XAssistant Behavior AnalystRBT-16-17891CA

General Provider Information

NPI Number : 1184124661
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONNIEANN SOPER
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 865 MARINA BAY PKWY BLDG C
Second Line :
City : RICHMOND
State : CA
Zip : 94804-6495
Country : US
Telephone Number : 510-422-6311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 02/20/2018

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